Is he mentally ill?

Course of alcoholism is erratic and fluctuating

• Course of alcoholism is erratic and fluctuating

• Often don’t seek help but appear in hospitals and jails. About 25,000 highway deaths per year—1/2 of total. ½ of all murders.

• Losses dues to medical treatment, lost productivity, losses due to death cost society about 200 billion annually

• Lower levels of ETOH abuse associated with ---marriage, being older, and higher levels of education

• Comorbid with antisocial, mania, other drug use, schizophrenia, panic

• Short term effects:

• Doesn’t undergo digestion. Instead into small intestine and into blood. Absorption is rapid; removal is slow.

• Depressant on CNS—sedation, sleep

• Expectancy effects

Commonly:

• Commonly:

• Decreased sexual inhibition
• Lowered sexual performance
• Lapses of memory
• Hangover

• Low levels—stimulate brain cells activating pleasure areas of brain

• Higher levels—depress brain functioning inhibiting glutamate—leads to impaired learning, judgment, and self-control

• Effects of alcohol vary by drinker depending on tolerance, amt of food in stomach, physical condition, duration of drinking

• Physical effects of chronic use:

• Cirrhosis in 15-30% of chronic drinkers; 27,000 deaths per year
• High caloric content can reduce the consumption of other foods leading to malnutrition
• Can cause nutritional deficiencies—interferes with ability to utilize nutrients
• Delirium tremens—disorientation, hallucinations, fear, tremors—lasts 3-6 days, death rates have declined due to drugs that help
• Korsakoff’s—memory, confabulation

• Fetal alcohol syndrome—

Bio—2 keys

• Bio—2 keys

• 1) Ability of addictive drugs to activate areas of the brain that produce intrinsic pleasure and immediate powerful reward
• 2) Person’s biological makeup including genetic inheritance

• Psychosocial causes

• Psychological vulnerability
• Emotionally immature; impulsive, aggressive; require an inordinate amt of praise; expect a great deal of the world; low frustration tolerance
• Stress, tension reduction
• Expectations of social success
• Family relationship factors
• Presence of an alcoholic father
• Acute marital conflict
• Lax maternal supervision, inconsistent discipline
• Many family moves during early years
• Lack of attachment to father
• Lack of family cohesiveness

Medications—block the desire to drink or reduce the side effects of withdrawal

• Medications—block the desire to drink or reduce the side effects of withdrawal

• Psychological treatments-

• Group therapy
• Environmental interventions—alleviate aversive life situation
• Behavior and cognitive behavior
• Aversive conditioning
• Skills training for younger drinkers
• Self-control training

• Controlled drinking—about 15-18% succeed with controlled drinking

• AA—dropout rates of about 50%; better than no tx

• Outcome studies and issues in treatment

• Low rates of success among hard-core substance abusers
• Recovery rates of a 70-90% with modern tx and aftercare
• Favorable outcomes—motivation to change and a positive relationship with therapist
• Drinking Check Up sessions—early stages help

• Relapse prevention

• Recognize indulgent behaviors
• Recognize apparently irrelevant decisions that serve as early warning signals

Opium in use for thousands of years

• Opium in use for thousands of years

• Morphine—powerful sedative and pain reliever—treated with acetic anhydride, you get heroin—more rapid and intense

• Commonly smoked, snorted eaten, skin popped or mainlined

• Withdrawal occurs after extended use within 8 yrs

• Withdrawal—many withdraw without help; others experience runny nose, tearing eyes, perspiration, restlessness, etc

• Social effects—centered on obtaining drug; leads to lying, stealing, etc.; disease like AIDS

• Three most common reasons cited: pleasure, curiosity, peer pressure

• Narcotics subculture

• Withdrawal does not reduce craving

• Methadone tx—newer bupenorphine—fewer side effects

• Similar psych to alcoholism

Cocaine creates 4-6 hr euphoric state

• Cocaine creates 4-6 hr euphoric state

• Abuse—acute toxic psychotic sx—visual, auditory, tactile hallucinations
• Sleeplessness
• Some meds to reduce cravings
• Must address feelings of tension and depression

• Amphetamines

• Used to treat ADHD and for appetite suppression
• Effects—psychologically and physically addictive
• Rapid tolerance
• High bp, enlarged pupils, unclear/rapid speech, loss of appetite, sweating, confusion, sleeplessness

• Withdrawal is physically painless; can be some cramping, nausea, diarrhea; depression may be a sx of abrupt withdrawal

Effects—calming, induce sleep; excessive use leads to tolerance and dependence but tolerance does not increase the amt needed to cause death

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